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MASSACHUSETTS 

AGRICULTURAL 

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LAMINITIS. 


Its    Nomenclature,   Nature,   Etiology,    Symptoms,   Course, 
Complications  and   Treatment. 


CONTRIBUTION 


Veterinary  Pathology, 


A.  A.  HOLCOMBE,  D.V.S, 

Professor  of  Surgical  Patliology  and  Obstetrics  in  the  American 
Veterinary  College. 


NEW  YORK : 

A.   N.    Davis'  Job  Printing  House, 

60  University  Place, 
1880. 


NOTE  FROM  THE  AUTHOR. 

<UAi'.  O  :2<50  — 

The  researches  which  I  have  made  during  the  past  two 
years,  into  the  pathology  of  Laminitis,  have  brought  me  to 
conclusions,  in  part  so  much  at  variance  with  those  set  forth 
in  the  text-books  which  I  have  seen,  that  I  am  prompted  to 
give  the  profession  my  views  on  the  subject  in  this  monogram. 

I  have  treated  of  the  disease  in  exteiiso,  in  that  the  prophy- 
lactic, as  well  as  remedial,  treatment  might  be  fully  under- 
stood, hoping  thereby  to  prevent  avoidable  suffering,  too  often 
the   result  of  mistaken    kindness,  and  to  relieve   that   already 

induced. 

A.  A.  HOLCOMBE, 

141  W.  54th  Street,  N.  Y.,  City. 


LAMINITIS. 


NOMENCLATURE. 


By  what  term  this  disease  was  first  known  to  man  is  a 
question  unanswerable.  During  many  years  in  the  recent  past, 
and  before  an  approximate  knowledge  of  its  lesions  was  had, 
it  was  usually  designated  as  "  Founder." 

In  country  districts,  and  amongst  the  great  majority  of  the 
laity,  this  name  is  yet  almost  exclusively  used,  and,  undoubt- 
edly, it  was  first  so  employed  because  of  its  conveyed  expres- 
siveness of  the  physical  inability,  or  disinclination,  upon  the 
part  of  the  patient  to  proceed  in  his  gait,  resembling  thereby 
a  ship  similarly  disabled.  That  it  could  have  been  adopted 
upon  any  other  ground,  hardly  seems  possible,  for  the  etymol- 
ogy of  the  term  does  not  indicate  that  it  was  so  used  because 
it  contained  even  the  most  remote  intimation,  either  as  to  the 
seat  of  the  disease,  its  nature,  or  its  cause. 

Webster,  in  his  Dictionary,  gives  as  one  of  the  definitions 
to  the  term  :  "  To  trip  ;  to  fall  ;  to  stumble  and  go  lame."  This 
definition  is  very  truly  descriptive  of  the  most  notable  symp- 
toms of  the  disease,  and  particularly  so  of  the  chronic  form  ; 
but  it  does  not  serve  in  the  least  to  distinguish  between  any 
of  the  many  diseases  which  cause  tripping,  stumbling  and  lame- 
ness— objections  which  are  fatal  to  its  employment  in  a  scien- 
tific sense. 

Since  the  days  of  Youatt,  when  symptomatology  exercised 
so  important  an  influence  in  the  naming  of  all  diseases,  this 
term  has  gradually  given  way  to  the  more  modern   "  Lamin- 


4  LAMINITIS. 

itis,"  Avhich  now  finds  recognition  in  all  the  text-books  on 
veterinary  surgery. 

But  while  this  last  and  generally  accepted  term  is  an  ex- 
pressive one,  based  on  an  anatomico-pathological  knowledge 
of  the  disease,  it  is  not  strictly  correct  ;  for  it  leaves  the  im- 
pression that  eitJier  or  both  sets  of  the  laminae  might  be  the 
seat  of  inflammation — an  impossibility  upon  the  part  of  the 
horny  tissue.  Furthermore,  it  conveys  the  idea  that  only  the 
laminae  are  affected,  whereas  in  many  instances  the  velvety  tis- 
sue is  also  implicated — not  as  a  complication,  but  as  a  part  of 
the  primary  disease. 

A  better  term  would  be  found  in  Podophyllitis;  for  this 
would  designate  the  sensitive  laminae,  or  podophyllous  tissue, 
as  the  seat  of  the  disease.  Yet  the  same  objection  is  applicable 
here  as  in  the  case  of  laminitis,  regarding  the  exclusion  of  the 
velvety  tissue. 

The  name  coming  nearest  perfection  in  its  comprehensive- 
ness, if  our  knowledge  of  the  pathology  of  the  disease  is  cor- 
rect, would  be  "  Keratitis;"  for  it  could  rightfully  be  employed 
to  designate  inflammation  of  all,  or  any  part  of  the  keratogen- 
ous  membrane.  But,  laying  aside  our  objections  to  the  defects 
in  the  adopted  term  of  Laminitis,  and  accepting  it  broadly  as 
meaning  inflammation  of  the  sensitive  lamina;  and  velvety  tis- 
sues of  the  foot,  it  is  still  very  generally  misused  by  the  pro- 
fession in  describing  simple  congestion  of  the  keratogenous 
membrane. 

So  also  does  it  seem  to  me  an  error  to  apply  this  term  to 
that  occasional  condition  where  Ostitis  and  Periostitis  of  the 
pedal  bone,  are  of  far  more  importance  than  the  accompanying 
Laminitis.  It  is  probably  true  that  in  nearly  all  these  cases 
inflammation  of  the  laminae  precedes  that  of  the  other  tissues  ; 
for,  because  of  their  different  anatomical  structure,  bone  and 
periosteum  are  much  more  slow  to  respond  to  irritation  than 
are  the  laminae  ;  yet,  since  the  producing  or  exciting  cause  is 
one  and  the  same  in  all  these  complications,  and  since  the  dis- 
ease of  the  bone  and  its  covering,  are  much  the  more  serious, 
it  would  seem  that  we  might  do  better  did  we  accept  Williams' 
suggestion  and  call  these  mixed  cases  "  Peditis." 


LAMINITIS. 


NATURE. 


Of  the  nature  of  Laminitis  but  little  is  to  be  said  ;  it  being- 
a  simple  non-specific,  non-contagious,  and  non-infectious  in- 
flammation, characterized  by  the  general  phenomena  attending 
inflammation  of  the  skin  and  mucous  membranes,  producing  no 
constitutional  disturbances,  except  those  dependent  upon  the 
local  disease  ;  and  having  a  strong  tendency,  in  severe  cases, 
to  destructive  disorganization  of  the  tissues  affected. 

ETIOLOGY. 

The  causes  of  Laminitis  are  as  wide  and  variable  as  in  any 
of  the  local  inflammations,  and  may  be  divided  into  two  classes  : 
the  predisposing  and  exciting. 

Predisposing    Causes. 

From  personal  observations  I  do  not  know  that  any  par- 
ticular construction  of  foot,  or  any  special  breed  of  horses  are 
thereby  predisposed  to  this  disease  ;  neither  can  I  find  any- 
thing to  warrant  the  assumption  that  it  is  in  any  way  heredi- 
tary ;  so  that  while  we  may  easily  cultivate  a  predisposition  to 
the  disease  upon  the  part  of  the  tissues  subject  to  become 
affected,  the  disease  itself  does  not  originate  without  an  excit- 
ing cause.  Like  most  other  tissues,  a  predisposition  to  inflam- 
mation ma}'  be  induced  in  the  sensitive  laminse  by  any  cause 
which  lessens  their  power  of  withstanding  the  work  imposed 
on  them.  It  exists,  to  an  extent,  in  those  animals  unaccustomed 
;  to  work,  particularly  if  they  are  plethoric,  and  in  all  those  that 
,  have  been  previous  subjects  of  the  disease — for  the  same  rule 
holds  good  here  that  we  find  in  so  many  diseases — i.  e.,  that 
one  attack  impairs  the  functional  activity  of  the  affected  tis- 
sues, and  thus  renders  them  more  easy  of  a  subsequent  inflam- 
mation. 

Unusual  excitement,  by  determining  an  excessive  blood 
supply  ;  bad  shoeing  ;  careless  paring  of  the  feet  by  removing 
the  sole  support,  as  well  as  high  calkings  without  correspond- 
ing toe-pieces,  inust  be  included  under  this  head. 


O  LAMINITIS. 

Exciting   Causes. 

The  exciting  causes  of  Laminitis  are  many  and  varied  ; 
the  most  common  being  concussion,  over-exertion,  exhaustion, 
rapid  changes  of  temperature,  ingestion  of  various  foods,  pur- 
gatives, and  the  oft-mentioned  metastasis.  In  conjunction  with 
these  WilHams  would  add  :  "  Excitement,  bad  shoeing,  paring 
of  the  feet,  tight  nailing  of  the  shoes,  and  high  calkings."  I 
do  not  believe  these  influences  can  rightly  be  classed  with 
the  exciting  causes,  but  have  placed  them  under  the  head  of 
predisposing  causes. 

I.  Concussion  acts  as  a  producer  of  this  disease  by  the 
local  over-stimulation  which  it  occasions — the  excessive  ex- 
citement being  followed  by  an  almost  complete  exhaustion  of 
the  functional  activity  of  the  keraphyllous  tissue  ;  the  exhaus- 
tion by  congestion,  and  eventually  by  inflammation.  But  con- 
gestion here,  as  in  all  other  tissues,  is  not  necessarily  always 
followed  by  inflammation  ;  for  although  the  principal  symp- 
toms belonging  to  true  Laminitis  are  present,  the  congestion 
may  be  relieved  before  the  processes  of  inflammation  are  fully 
established. 

This  is  the  condition  that  obtains  in  the  many  so-called 
cases  of  Laminitis  which  recover  in  from  twenty-four  to  forty- 
eight  hours'  time.  These  are  the  cases  which  should  be  called 
Congestion  of  the  Laminae,  or  Congestion  of  the  Keratogenous 
Membrane;  for  there  is,  in  truth,  no  inflammation  present,  and 
the  profession  seems  to  have  forgotten,  or  overlooked,  the  fact 
that  simple  congestion  here  was  a  possibility. 

Laminitis  from  concussion,  is  common  in  track-horses  trot- 
ting races  when  not  in  condition,  especially  if  they  are  carrying 
the  obnoxious  toe-weights  ;  and  in  green  horses  put  to  work 
on  city  pavements,  to  which  they  are  unaccustomed.  Concus- 
sion from  long  drives  on  dirt-roads,  is  at  times  productive  of 
the  same  results  ;  notably  when  the  weather  is  extremely  warm, 
or  at  least  when  the  relative  change  of  temperature  is  great. 
But  undoubtedly  the  exhaustion  so  apt  to  be  produced  under 
these  circumstances,  must  be  considered  as  exerting  almost  as 
great  an  influence  as  an  exciting  cause,  as  does  the  long-con- 


LAMINITIS.  7 

tinued  concussion.  This  same  combination  of  causes  must 
also  be  admitted  as  determining-  the  disease  when  seen  at 
times  in  hunters  ;  for  the  imposed  weight  of  the  rider  increases 
the  demands  made  upon  the  function  of  these  tissues,  and 
their  powers  of  resisting  congestion  and  its  consequences,  are 
the  sooner  exhausted. 

2.  Over-exertion — as  heavy  pulling  or  rapid  work,  even 
where  there  is  no  chance  for  immoderate  concussion,  occasion- 
ally results  in  this  disease;  although  in  the  majority  of  in- 
stances exiiaustion  is  a  conjunctive  cause,  for  over-exertion 
cannot  be  long  continued  without  inducing  this  condition. 

3.  Exhaustion,  in  whatever  manner  produced,  is  nearly  as 
prolific  a  source  of  Laminitis  as  is  concussion  ;  for  when  the 
physical  strength  has  been  greatly  impaired,  even  though  but 
temporarily,  some  part  of  the  economy  is  rendered  more  vul- 
nerable to  disease  than  others,  and  it  is  not  strange  that,  in 
many  instances,  it  should  be  those  parts  still  called  upon  to 
perform  their  function  of  maintaining  the  weight  of  the  body 
after  their  activity  has  been  exhausted.  It  is  to  this  cause  we 
must  ascribe  those  many  cases  which  we  see  following  a  hard 
day's  work,  where  at  no  time  has  there  been  over-exertion  or 
immoderate  concussion. 

In  the  same  manner  a  strong  tendency  to  Laminitis  is  in- 
duced in  horses  on  sea-voyages  ;  the  exhaustion  of  the  laminae 
resulting-  from  the  continual  constrained  position  which  the 
animal  is  compelled  to  maintain  on  account  of  the  rocking- 
motion  of  the  vessel. 

The  same  cause  exists  where  one  foot  has  been  blistered, 
or  where  one  limb  is  incapacitated  from  some  other  reason  ; 
lor  the  opposite  member,  being  called  on  to  do  double  duty, 
soon  becomes  exhausted,  and  congestion,  followed  by  inflam- 
mation results  as  a  matter  of  course.  Where  one  foot  only 
becomes  Lamanitic  it  is  customary  to  find  the  other,  or  cor- 
responding member,  participating  at  a  later  date  ;  not  always, 
as  we  are  told,  because  of  sympathy,  but  because  the  transfer 
of  all  tlie  functional  performance  to  the  one  foot,  proves  with- 
in itself  a  sufficient  exciting  cause. 


o  LAMINITIS. 

4.  Rapid  changes  of  temperature  act  as  an  exciting  cause 
of  Laminitis,  in  precisely  the  same  way  as  they  act  to  produce 
disease  in  other  tissues — the  result  of  these  variations  of  tem- 
perature showing  itself  upon  those  parts  rendered  particularly 
susceptible  to  pathological  changes  from  some  impairment  of 
their  natural  disease-resisting  powers. 

This  change  of  temperature  may  be  induced  by  drinking 
large  quantities  of  cold  water  while  in  an  over-heated  condi- 
tion. Here  the  internal  heat  is  rapidly  reduced,  the  neighbor- 
ing tissues  and  blood-vessels  constringed,  and  the  blood  supply 
to  these  organs  greatly  diminished  ;  while  the  quantity  sent 
to  the  periphery  is  correspondingly  increased.  True,  in  many 
of  the  cases  which  result  from  this  cause,  there  has  not  been 
sufficient  labor  performed  to  impair  the  powers  of  the  laminae, 
and  I  am  inclined  to  the  opinion  that  Laminitis  is  the  more 
readily  induced,  than  congestion  or  inflammation  of  the  skin  or 
other  peripheral  organs,  because  of  the  impossibility  upon  the 
part  ot  the  laminae  to  relieve  themselves  of  the  threatened 
congestion  by  the  general  safety-valve  of  perspiration. 

A  cold  wind,  or  relatively  cold  air  allowed  to  play  upon 
the  body  when  heated  and  wet  with  sweat,  has  virtually  the 
same  result  ;  for  it  arrests  evaporation,  and  rapidly  cools  the 
external  surface,  thereby  determining  an  afflux  of  blood  to 
such  organs  and  tissues  as  are  protected  from  this  outside  in- 
fluence. In  many  instances  this  happens  to  be  some  of  the 
internal  organs,  as  the  lungs,  where  the  previous  work  has 
been  rapid  and  their  functional  activity  impaired  ;  but  in  nu- 
merous other  instances  the  determination  is  toward  the  feet,  and 
that  it  is  so,  depends  upon  two  very  palpable  facts — first :  that 
these  tissues  have  been  greatly  excited,  and  are  already  receiv- 
ing as  much  blood  as  they  can,  consistently  with  health,  ac- 
commodate ;  secondly  :  even  though  these  tissues  are  classed 
with  the  peripheral  ones,  their  protection  from  atmospheric 
influences  by  means  of  the  thick  box  of  horn  encasing  them, 
renders  them,  in  this  respect,  equivalent  to  internal  organs. 

Again  :  a  still  more  limited  local  action  of  cold  excites 
this  disease,  as  seen  from  driving  through  water,  or  washing  the 
feet  or  legs  while   the  animal   is  warm,  or  just  in  from  work  ; 


LAMINITIS.  9"' 

here  a  very  marked  reaction  takes  place  in  the  peripheral  tis- 
sues of  the  limbs,  and  passive  congestion  of  the  foot  results 
from  the  interference  with  the  return  flow  of  blood  being  sent 
to  the  organs  in  excess.  These  are  more  apt  to  be  simple 
cases  of  congestion,  soon  to  recover  ;  yet  they  may  become 
true  cases  of  Laminitis.  Youatt  says  :  "  The  danger  is  not 
confined  to  the  change  from  heat  to  cold  ;  a  sudden  transition 
from  cold  to  heat  is  as  injurious,  and  therefore  it  is  that  so 
many  horses  after  having  been  ridden  far  in  frost  and  snow, 
and  placed  immediately  in  a  hot  stable,  and  littered  up  to  the 
knees,  are  attacked  by  this  complaint."  I  have  never  seen 
the  disease  occur  under  exactly  similar  circumstances,  but  am 
inclined  to  believe,  that  in  these  cases,  the  disease  was  attrib- 
uted to  the  zvronp  cause — the  excitement,  exhaustion,  and  con- 
cussion  of  the  long  ride  being,  apparently,  entirely  overlooked. 
Furthermore,  if  we  consider  the  physical  conditions  which  must 
necessarily  be  present  under  the  circumstances,  it  seems  incon- 
sistent with  our  knowledge  of  the  effects  of  heat  and  cold,  to 
believe  the  very  moderate  temperature  of  stables,  and  the  heat- 
producing  properties  of  bedding  "up  to  the  knees,"  could  be 
productive  of  Laminitis. 

Rather  should  we  say  that  such  favorable  circumstances 
would  be  conducive  to  opposite  results. 

5.  Why  it  is  that  certain  kinds  of  grain  will  cause  Laminitis, 
does  not  seem  to  be  clearly  understood.  Certainly  they  pos- 
sess no  specific  action  upon  the  laminae,  for  all  animals  are  not 
alike  affected  ;  neither  do  they  always  produce  these  results  in 
the  same  animal.  In  the  case  of  some  of  these  aliments,  where 
their  ingestion  causes  a  strong  tendency  to  indigeston,  the 
consequent  irritation  of  the  alimentary  canal  may  be  so  great 
as  to  warrant  the  belief  that  the  laminae  are  affected  through 
sympathy.  In  other  instances  there  is  no  apparent  interfer- 
ence with  digestion,  nor  evidence  of  any  irritations  of  the  mu- 
cous membranes  ;  yet  the  disease  is,  in  some  manner,  depend- 
ent upon  the  food  in  question  for  its  inception.  Barley,  Wheat, 
and  sometimes  Corn,  are  the  grains  most  prolific  in  the  produc- 
tion of  this  disease.  With  some  horses  there  appears  to  be  a 
particular  susceptibility  to  this  influence  of  Corn.     In  such  in- 


lO  LAMINITIS. 

stances  the  feeding  of  this  grain  for  a  few  days  will  be  followed 
by  inflammation  of  the  feet  lasting  from  a  few  days  to  two 
weeks'  time.  In  these  animals,  to  all  appearances  healthy,  the 
corn  neither  induces  colic,  indigestion  nor  purging,  and,  appar- 
ently, no  irritation  whatever  of  the  alimentary  canal. 

6.  Fortunately  purgative  medicines  but  rarely  become  the 
exciting  cause  of  inflammation  of  the  laminae.  That  it  is  then 
the  result  of  a  sympathetic  action  upon  the  part  of  the  tis- 
sues affected,  is,  no  doubt,  more  than  hypothetical  ;  for  when 
there  is  no  derangement  of  the  alimentary  canal  existing,  a 
dose  of  cathartic  medicine  will,  at  times,  bring  on  severe  Lam- 
initis,  and  that  too  before  purgation  commences. 

Williams  very  ingeniously  explains  this  sympathy  of  action 
by  remarking  that  the  skin,  mucous  structures  and  laminae  are 
continuous  one  with  another,  and  secretory  ;  that  their  secre- 
tions are  similar  ;  that  irritation  of  one  tends  to  spread  to  the 
others,  and  although  so  slight  in  the  skin  as  hardly  to  be 
noticed,  it  becomes  the  source  of  an  acute  inflammation  in  the 
sensitive  tissues  of  the  laminae  surrounded  as  they  are  by  un- 
yielding structures  If  this  be  the  true  explanation,  it  is  re- 
markable that  diseases  of  the  skin  are  not  accompanied  by 
affections  of  the  laminae;  for  they  are  more  nearly  related  by 
contiguity,  than  are  the  mucous  membranes  and  the  laminae. 
At  the  same  time  I  am  inclined  to  doubt  the  presence  of  skin 
disease  as  a  cause  for  the  slow  healing  of  wounds  during  the 
course  of  Laminitis,  as  is  claimed  by  Williams  ;  but  rather 
would  attribute  such  tendency  to  blood-changes. 

7.  Most,  if  not  all,  the  older  authorities  were  agreed  that 
Metastatic  Laminitis  is  a  reality.  That  such  a  condition  ever 
does  exist  outside  the  imagination  certainly  awaits  the  prov- 
ing. 

That  Laminitis  may  and  oftimes  does  exist  as  a  concurrent 
disease  with  numerous  others,  is  unquestionably  true  ;  but  to 
believe  an  inflammation  can  be  almost  momentarily  transferred 
from  one  organ  to  another,  no  matter  how  remote,  is  to  de- 
stroy all  belief  in  our  knowledge  of  the  pathology  of  this  com- 
plicated process.     We  do  not  pretend  to  deny  that  the  indue- 


LAMINITIS.  ri 

tion  of  Laminitis  during  the  course  of  some  other  disease,  may 
serve  to  arrest  the  further  invasion  of  healthy  tissue  by  the 
primar}^  process,  or  that  it  may  exert  a  remedial  influence  upon 
the  first  disease  ;  but  it  cannot  and  does  not  at  once  remove 
that  inflammation  and  obliterate  its  lesions  ;  for  the  products 
of  any  inflammation,  be  it  never  so  simple,  require  a  certain 
time  for  their  removal,  and  it  is  impossible  that,  for  instance, 
the  products  of  inflamed  lung  tissue  can  be  immediately  re- 
moved, and  the  inflammation  in  whole  transferred  to  the  lam- 
inae. There  is  no  manner  of  removing  such  inflammatory  pro- 
ducts, except  by  the  natural  means  of  the  lymphatics  and 
blood  vessels,  and  even  these  very  efficient  absorbents  are 
powerless  to  accomplish  their  functions  until  degenerative  pro- 
cesses have  rendered  the  products  fluid.  This  liquifaction  can- 
not be  accomplished  in  the  short  time  required  for  the  develop- 
ment of  Laminitis  in  these  so-called  metastatic  cases  ;  and  just 
so  long  as  the  products  of  the  inflammation  remain  in  the  tis- 
sues in  an  unchanged  form,  just  so  long  will  you  have  the  usual 
symptoms  belonging  to  the  disease.  Furthermore,  since  no 
inflammation  can  exist  without  characteristic  lesions  being 
produced,  neither  can  it  be  removed  until  the  lesions  have  in' 
some  manner  been  repaired.  Metastatic  Laminitis  then  is 
nothing  more  nor  less  than  concurrent  Laminitis,  and  as  such, 
presents  little  in  anyway  peculiar  outside  the  imperfectly  un- 
derstood exciting  cause  ;  and  the  practitioner  who  allows  the 
acute  symptoms  of  the  Laminitis  to  mislead  him,  simply  be- 
cause their  severity  has  overshadowed  those  of  the  primary 
disease,  may  lose  his  case  through  unguarded  subsequent  treat- 
ment. This  form  of  Laminitis  is  by  no  means  commonly  met 
with,  but  when  seen,  will  usually  be  found  in  conjunction  with 
Pneumonia ;  according  to  Youatt,  with  inflammation  of  the 
bowels  and  eyes,  and  according  to  Law  and  Williams,  some- 
times with  Bronchitis. 

SYMPTOMS. 

Laminitis  is  characterized  by  a  congregation  of  symptoms 
so  well-marked  as  scarcely  to  be  misinterpreted  by  the  most 
casual    observer.     They  are  nearly  constant. in  their  manifes- 


12  LAMINITIS. 

tations,  modified  by  the  number  of  feet  affected,  the  cause 
which  has  induced  the  disease,  the  previous  condition  of  the 
patient,  and  the  various  other  influences  which  operate  in  all 
diseases  to  some  extent.  They  may  be  divided  into  general 
symptoms — which  are  concomitants  of  all  cases  of  the  disease, 
subject  to  variations  in  degree  only  ;  and  special  symptoms,  or 
those  which  serve  to  determine  the  feet  affected  and  the  com- 
plications which  may  arise. 

General  Symptoms . 

Usually  the  first  symptom  that  would  indicate  any  definite 
obstruction  to  functional  performance,  is  the  interference  with 
locomotion  produced  by  congestion  of  the  keratogenous  mem- 
brane. Occasionally,  the  other  symptoms  are  presented  first. 
With  the  development  of  the  lameness  the  pulse  will  be  found 
accelerated,  full,  hard  and  striking  the  finger  strongly  ;  the 
temperature  soon  rises  several  degrees  above  the  normal  reach- 
ing, sometimes  io6"  F.,  although  it  generally  ranges  between 
I02  \-2^  and  105"".  The  respirations  are  rapid  and  panting  in 
character,  the  nostrils  being  widely  dilated,  and  the  mucous 
membranes  highly  injected.  The  facial  expression  is  anxious 
and  indicative  of  the  most  acute  suffering,  while  the  body  is 
more  or  less  bedewed  with  sweat.  At  first,  there  may  be  a 
tendency  to  diarrhoea,  or  it  may  appear  later,  particularly,  as 
the  result  of  medication.  The  urine  is  high  colored,  scant  in 
quantity  and  of  increased  specific  gravity,  owing  to  the  water 
from  the  system  being  eliminated  by  the  skin  instead  of  the 
kidneys.  The  appetite  is  impaired  and  sometimes  entirely 
lost,  while  the  thirst  is  greatly  increased.  The  affected  feet 
are  hot  and  dry  to  the  touch  ;  they  are  relieved  as  much  as 
possible  from  bearing  weight  ;  rapping  them  with  a  hammer, 
or  compelling  the  animal  to  stand  upon  one  affected  member, 
causes  intense  pain,  while  the  digital  artery  throbs  beneath 
the  finger. 

Special  Symptoms. 

Liability  to  affection  varies  in  the  different  feet  according 
to  the  exciting  cause.  Any  one,  or  more,  of  the  feet  may  be- 
come  the   subject  of  this   disease,  although    it  appears   more 


LAMINITIS.  13 

often  in  the  fore  feet  than  in  the  hind  ones, — a  fact  owing  to 
the  difference  of  function,  /.  e.,  that  the  fore  feet  are  the  bases 
of  the  columns  of  support,  receiving  nearly  all  the  body's  weight 
during  progression,  and  consequently  most  of  the  concussion  ; 
while  the  hind  feet  at  such  times  become  simply  the  fulcra  of 
the  levers  of  progression,  and  are  almost  exempt  from  con- 
cussion. 

One  Foot. — Injuries  and  excessive  functional  perform^ance 
are  the  causes  of  the  disease  appearing  in  only  one  foot ;  here 
the  general  symptoms,  as  a  rule,  are  not  severe,  there  often 
being  no  loss  of  appetite,  and  no  unusual  thirst,  while  the  pulse 
temperature,  and  respirations  remain  about  normal.  In  these 
instances  the  weight  of  the  body  is  early  thrown  upon  the  op- 
posite foot,  and  the  diseased  one  is  extended,  repeatedly  raised 
from  the  floor,  and  then  carefully  replaced.  When  made  to 
move  forward,  the  lame  foot  is  either  carried  in  the  air  while 
progression  is  accomplished  by  hopping  with  the  healthy  one, 
or  else  the  heel  of  the  first  is  placed  on  the  ground  and  re- 
ceives the  little  weight  thrown  upon  it,  while  the  sound  limb 
is  quickly  advanced.  Progression  in  a  straight  line  is  much 
more  easily  accomplished,  than  is  turning  toward  the  lame 
side. 

Both  Fore  Feet. — When  both  fore  feet  are  affected,  the 
symptoms  are  well  marked.  The  lameness  is  excessive,  and 
the  animal  almost'immovable.  When  standing,  the  head  hangs 
low  down,  or  rests  upon  the  manger  as  a  means  of  support  and 
.to  relieve  the  feet  ;  the  fore  feet  are  well  extended  so  that  the 
weight  is  thrown  upon  the  heels,  where  the  tissues  are  least 
sensitive,  least  inflamed,  and  most  capable  of. relief  from  free 
effusion.  The  hind  feet  are  brought  forward  beneath  the  body 
to  receive  as  much  weight  as  possible,  thereby  relieving  the  dis- 
eased ones.  If  progression  is  attempted,  which  rarely  happens 
voluntarily  during  the  first  three  or  four  days,  it  is  accomplished 
with  very  great  pain  and  lamtness  at  the  starting,  which  usu- 
ally subsides  to  an  extent  after  a  few  minutes  exercise.  Dur- 
ing this  exercise,  if  the  animal  happens  to  step  upon  a  small 
stone,  or  other  hard  substance,  he  stumbles   painfully  onto  the 


14  LAMINITIS. 

other  foot,  and  is  excessively  lame  in  the  offended  member  for 
a  number  of  steps,  owing  to  the  acute  pain  which  pressure 
upon  the  sole  causes  in  the  tissues  beneath.  The  manner  of 
the  progression  is  pathognovionic  of  the  complaint.  Some- 
times the  affected  feet  are  simultaneously  raised  from  the 
ground,  (the  hind  ones  meanwhile  sustaining  the  weight),  then 
advanced  a  short  distance  and  carefully  replaced,  while  at  al- 
most the  same  moment  the  hind  ones  are  quickly  shuffled  for- 
ward near  to  the  centre  of  gravitation. 

In  other  instances  one  foot  at  a  time  is  advanced  and 
placed  with  the  heel  upon  the  ground  in  the  same  careful  man- 
ner;  all  causes  of  concussion  being  carefully  avoided.  In  at- 
tempting to  back  the  animal,  he  is  found  to  be  almost  station- 
ary, simply  swaying  the  body  back  on  the  haunches,  and  elevat- 
ing the  toes  of  the  diseased  feet,  as  they  rest  upon  their  heels. 
In  attempting  to  turn  him  either  to  the  right  or  left,  he  allows 
his  head  to  be  drawn  to  the  one  side  to  its  full  extent  before 
moving,  then  makes  his  hind  feet  the  axis  around  which  the 
forward  ones  describe  a  shuffling  circle. 

In  a  majority  of  cases  of  Laminitis  in  the  fore  feet,  the 
animal  persists  in  standing  until  he  is  nearly  recovered.  In 
other  cases  he  as  persistently  lies,  standing  only  when  neces- 
sity seems  to  compel  it,  and  then  for  as  short  a  time  as  possible. 
If  the  recumbent  position  is  once  assumed,  the  relief  experi- 
enced from  a  removal  of  the  weight  of  the  body  off  the  in- 
flamed tissues,  tempts  the  patient  to  seek  it  again,  and  so  we 
often  find  him  down  a  greater  part  o\  the  time.  But  this  is  not 
true  of  all  cases,  for  sometimes  he  will  make  the  experiment, 
then  cautiously  guard  against  a  repitition.  Even  in  those  cases 
of  enforced  recumbency,  he  oftimes  takes  advantage  of  the 
first  opportunity  and  gets  upon  his  feet,  doggedly  remaining 
there  until  again  laid  upon  his  side  by  his  attendants.  How  to 
explain  this  diversity  of  action  I  do  not  know,  for  theoretically 
the  recumbent  position  is  the  only  appropriate  one,  except 
when  complications  exist,  and  the  one  which  should  give  the 
most  comfort,  yet  it  is  rejected  by  very  many  patients,  and  no 
doubt  for  some  good  reason.  It  has  been  suggested  as  an  ex- 
planation, that  when  the  animal  gets  upon  his  feet  after  lying 


LAMINITIS.  1 5 

for  a  time,  the  suffering  is  so  greatly  augmented,  that  the  mem- 
ory of  this  experience  deters  him  from  an  attempted  repeti- 
tion. If  this  were  true,  the  horse  with  the  first  attack  of  this 
disease,  must  necessarily  make  the  experiment  before  knowing 
the  after  effects  of  lying  down,  yet  many  remain  standing 
without  even  an  attempt  at  gaining  this  experimental  knowl- 
edge. 

The  most  favored  position  of  the  animal  when  down,  is  on 
the  broad-side,  with  the  feet  and  legs  extended.  While  in  this 
position  the  general  symptoms  greatly  subside  ;  the  respira- 
tions an4  pulse  become  almost  normal  ;  the  temperature  falls, 
and  the  perspiration  dries.  It  is  mostly  with  difficulty  that  he 
is  made  to  rise,  and  when  he  attempts  it,  gets  up  rapidly  and 
"  all  in  a  heap"  as  it  were,  shifting  quickly  from  one  foot  to  the 
other,  until  they  become  accustomed  again  to  the  weight 
thrown  upon  them.  Occasionally  a  patient  will  get  up  like  a 
cow,  rising  upon  the  hind  feet  first.  Although  enforced  exer- 
cise relieves,  to  some  extent,  the  soreness,  it  is  but  temporary, 
for,  after  a  few  minutes  rest,  it  returns  again  with  all  its  former 
severity. 

Both  Hind  Feet. — When  only  both  hind  feet  are  affected, 
they  are,  while  standing,  maintained  in  the  same  position  as 
when  only  the  fore  ones  are  the  subjects  of  the  disease  ;  but 
with  an  entirely  different  object  in  view.  Instead  of  being  here 
to  receive  weight,  they  are  so  advanced  in  that  the  heels  may 
receive  whatever  weight  is,  from  necessity,  imposed  on  them  ; 
the  fore  feet  being,  at  the  same  time,  placed  well  back  beneath 
the  body  where  they  become  the  main  supports  ;  the  animal 
standing,  as  Williams  describes  it,  "  all  of  a  heap." 

Progression  is  even  more  difficult  now  than  when  the  dis- 
ease is  confined  to  the  anterior  extremities.  The  fore  feet  are 
dubiously  advanced  a  short  distance,  and  the  hind  ones  then 
brought  forward  with  a  kind  of  a  kangaroo-hop,  which  results 
in  an  apparent  loss  of  equilibrium,  which  the  animal  is  a  few 
moments  in  regaining.  The  general  symptoms — or  in  other 
words,  the  degree  of  suffering — seem  more  severe  in  these 
cases,  than  where  the  disease  affects  the  fore  feet  alone.  The 
standing  position  is  not  often  maintained,  the  patient  seeking 


1 6  LAMINITIS. 

relief  in  recumbency.  This  fact  is  easily  understood,  when  we 
con:>ider  how  cramped  and  unnatural  is  the  position  he  assumes 
while  standing;  and  if  it  were  maintained  for  any  considerable 
length  of  time,  would,  no  doubt,  excite  the  disease  in  the  fore- 
feet as  explained  by  D'Arboval. 

All  Four  Feet. — Laminitis  of  all  four  feet  is  but  un- 
commonly met  with.  The  author  has  seen  but  three  such 
cases.  In  all  these,  the  position  assumed  was  nearly  normal, 
all  the  feet  being  slightly  advanced,  and  first  one,  then  another, 
momentarily  raised  from  the  ground  and  carefully  replaced  ; 
tlMS  action  being  kept  up  almost  continually  during  »the  time 
the  animal  remained  standing.  The  suffering  in  these  cases  is 
most  acute  ;  the  appetite  is  lost,  and  although  the  patient  lies 
most  of  the  time,  the  temperature  remains  too  high,  the  pulse 
and  respirations  are  greatly  accelerated,  the  body  covered  with 
sweat,  and  bed-sores  are  unpleasant  accompaniments. 

COURSE. 

The  course  which  Laminitis  takes,  varies  greatly  in  dif- 
ferent cases,  being  influenced  more  or  less  by  the  exciting 
cause,  the  animals  previous  condition,  the  acuteness  of  the 
attack  and  the  subsequent  treatment.  The  first  symptoms 
rarely  exhibit  themselves  while  the  animal  is  at  his  work,  al- 
though we  will  occasionally  see  the  gait  impaired  by  stumb- 
ling, the  body  covered  with  a  profuse  sweat  and  the  respiration 
become  blowing  in  character,  as  premonitions  of  the  oncom- 
ing disease. 

But  as  a  rule  nothing  is  noted  amiss  with  the  animal  un- 
til he  has  stood  for  some  time  after  coming  in  from  work,  when, 
in  attempting  to  move  him,  he  is  found  very  stiff.  Like  all 
congestions  the  early  symptoms  usually  develop  rapidly  ;  yet 
this  is  not  always  the  case,  for  in  some  instances  there  appears 
to  be  no  well-defined  period  of  congestion,  the  disease  seem- 
ingly commencing  at  ti  pointy  and  gradually  spreading  until  a 
large  territory  is  involved  in  the  morbid  process. 
Simple  Congestion. 

Those  cases  of  simple  congestion  of  the  laminae,  which  we 
erroneously  call  Laminitis,  are  rapidly  developed  ;   the  symp- 


LAMINITIS.  17 

toms  being  but  moderately  severe,  and  from  one  to  three  days 
required  for  recovery. 

There  are  no  structural  changes  here,  and  but  a  moderate 
exudate  which  is  rapidly  reabsorbed,  leaving  the  parts  precisely 
in  the  same  condition  as  they  were  previous  to  the  attack.  If 
the  congestion  has  been  excessive,  a  rupture  of  some  of  the 
capillaries  will  be  found  ;  a  condition  more  apt  to  obtain  where 
the  animal  is  made  to  continue  work  after  a  development  of 
symptoms  has  begun. 

True  the  majority  of  these  last  described  cases  prove  to  be 
Laminitis  in  fact,  yet  at  times  the  congestion  will  pass  away, 
and  the  extravasated  blood  be  absorbed  without  inflammation 
supervening  to  an  extent  sufficient  to  warrant  us  calling  it 
Laminitis.  The  seat  of  greatest  congestion  will  always  be 
found  in  the  neighborhood  of  the  toe,  because  of  the  increased 
vascularity  of'  that  part  ;  and  although  at  times  it  is  limited 
to  the  podophyllous  tissue  alone,  any  or  all  parts  of  the  kera- 
togenous  membrane  may  be  affected  by  the  congestion,  and 
followed  finally  by  inflammation. 

A  cute. 

In  the  acute  form  of  Laminitis,  the  symptoms  may  all 
develop  rapidly,  or  it  may  commence  by  the  appearance  of  a 
little  soreness  of  the  feet  during  progression,  which  in  twenty- 
four  or  forty-eight  hours'  time  has  passed  into  a  well-marked 
case.  This  peculiarity  of  development  is  due  to  one  of  two 
causes — either  the  congestion  is  general  but  takes  place  slowly, 
or  else  it  begins  in  one  or  more  points  and  gradually  spreads 
throughout  the  laminae.  These  acute  cases  generally  run  their 
course  in  from  a  few  days  to  two  weeks,  or  more  time.  Usu- 
ally a  culmination  of  the  symptoms  is  reached,  if  the  patient 
is  properly  treated,  in  from  three  to  five  days  ;  then  evidences 
of  recovery  are  discernible  in  favorable  cases.  The  lameness 
improves,  the  other  symptoms  gradually  subside,  and  eventually 
health  is  regained.  It  is  in  these  cases  that  a  strong  tendency 
to  disorganization  of  a  destructive  character  exists,  and  hence  it 
is  we  see  so  many  recover  imperfectly,  with  marked  structural 
changes   permanently  remaining.     The  inflammatory  exudate 


1 8  LAMINITIS. 

is  poured  out  into  the  keratogenous  membrane,  which  we  find 
swollen  to  the  greatest  degree  compatible  with  its  restricted 
capabilities.  This  exudate  is  rich  in  wandering  cells,  and  ac- 
cording to  Fleming,  "  a  large  quantity  of  hard  consistent  horn  '' 
is  deposited  on  the  surface  of  the  inflamed  tissues.  The  exuda- 
tion is  seen  in  greatest  quantity  at  the  toe  where  the  vessels  are 
most  profuse,  while  ooccasinally  extravasated  blood  is  found 
on  the  inner  surface  or  plates  of  the  keraphyllous  tissue.  Pur- 
ulent infiltration  sometimes  exists  to  a  limited  degree  without 
any  suppuration  occurring.  The  rich  plastic  infiltration  which 
has  taken  place,  ends  either  in  reabsorption,  or,  as  it  is  prone 
to  do,  in  the  development  of  new  connective  tissue  ;  while  the 
serous  exudate  and  extravasated  blood  are  readily  removed 
by  the  absorbents,  and  the  new  horn-material  becomes  organ- 
ized and  eventually  removed  by  the  off-growing  hoof. 

Sub -A  cute. 

Sub- Acute  Laminitis  is  most  often  seen  as  a  termination 
of  the  acute  form,  although  at  times  it  exists  independent  of 
or  precedes  an  acute  attack.  It  is  characterized  by  the  mild- 
ness of  its  symptoms,  slow  course,  and  moderate  tissue  changes. 
It  may  be  present  for  a  long  time  before  any  pathological  le- 
sions result,  other  than  those  found  in  the  acute  form,  and  when 
these   changes  do  take  place,   they  should  rather  be  viewed  as 

complications. 

Chronic. 

Chronic  Laminitis  is  a  term  used  by  many  to  designate 
any  of  the  sequelae  of  the  acute  and  sub-acute  forms  of  this 
disease.  Pure  chronic  inflammation  of  the  laminae  is  not  very 
commonly  met  with,  but  is  most  frequent  in  horses  that  have 
long  done  fast  track  work.  They  have  "  fever  in  the  feet  "  at 
all  times  and  are  continually  sore,  both  conditions  being  aggra- 
vated by  work.  Like  chronic  inflammation  of  other  parts  there 
is  a  strong  tendency  here  to  the  development  of  new  connec- 
tive tissue,  which  by  its  pressure  upon  the  blood  vessels  inter- 
feres with  nutrition.  Atrophy  of  the  os  pedis  and  periostitis 
with  caries  is  not  unusual.  The  continued  fever  and  impaired 
function  of  secretion,  results   in   the   production    of  horn,  defi- 


LAMINITIS.  19 

cient  in  elasticity,  somewhat  spongy  in  character  and  inclined 
to  crumble.  In  others  of  these  cases  of  "  soreness  "  in  horses 
used  to  hard  work,  there  is  evident  weakness  of  the  coats  of 
the  vessels  brought  on  by  repeated  functional  exhaustion. 
Here  slight  work  acts  as  an  exciting  cause  of  congestion,  which 
results  in  serous  effusion  and  temporary  symptoms  similar  to 
those  of  chronic  Laminitis.  Chronic  inflammation  of  the 
laminae  is  no  doubt  present  in  most  of  the  sequelae  of  Lamini- 
tis, but  it  is  not  the  most  important  nor  most  interesting  lesion, 
and  so  should  be  considered  only  as  an  adjunct  of  the  pro- 
cesses it  may  accompany. 

COMPLICATIONS. 

Complications  concurrent  with  or  supervening  upon  Lam- 
initis are  frequent  and  varied,  and  are  often  dependent  upon 
causes  not  fully  understood. 

Super-  Purgation . 

Super-purgation  is  one  of  the  simplest  of  these,  and  not 
usually  attended  with  dangerous  consequences.  It  rarely  occurs 
unless  induced  by  the  exhibition  of  a  purgative  ;  and  the  ex- 
cessive action  of  the  medicine  is  probably  to  be  explained  upon 
the  theory  that  the  mucous  membrane  sympathizes  with  the 
diseased  laminae,  is  irritable,  and  readily  becomes  over-excited. 
The  discharges  are  thin  and  watery,  sometimes  offensively 
odorous,  and  occasionally  persist  in  spite  of  treatment.  It  may 
prove  disastrous'  to  the  welfare  of  the  patient,  by  the  rapid  ex- 
haustion which  it  causes,  preventing  resolution  of  the  Lamin- 
itis, and  may  even  cause  death. 

SepticcBinia  and  Pycemia. 

Septicaemia  or  Pyaemia  are  unusual  complications,  and  are 
seen  only  in  the  most  severe  cases,  where  bed-sores  are  pres- 
ent, or  suppuration  of  the  laminae  results.  They  die,  as  a  rule, 
within  three  days  after  showing  signs  of  the  complication.  A 
further  consideration  of  the  condition  is  unnecessary  in  this 
connection. 


20  LAMINITIS. 

Metastatic  Pneumonia. 

Pneumonia — the  so-called  Metastatic — needs  no  especial 
consideration,  for  in  its  lesions  and  symptoms  it  does  not  differ 
from  ordinary  pneumonia,  although  it  may  be  over-looked  en- 
tirely by  the  practitioner.  Examinations  of  the  chest  in  Lam- 
initis  should  be  made  every  day,  so  as  to  detect  the  disease  at 
its  onset, and  render  proper  aid. 

Side-Bones. 

A  rapid  development  of  side-bones,  is  one  of  the  complica- 
tions, or  perhaps  better,  a  sequel  of  Laminitis,  not  often  met 
with  in  practice.  Here  the  inflammatory  process  extends  to 
the  lateral  cartilages  with  a  strong  tendency  to  calcification. 
The  deposition  of  the  lime-salts  is  sometimes  most  rapid,  so  that 
the  "bones"  are  developed  in  a  few  weeks'  time  ;  in  other  in- 
stances they  are  deposited  slowly,  and  their  growth  is  not 
noted  until  long  after  the  subsidence  of  the  Laminitis,  so  that 
the  exciting  cause  is  not  suspected.  This  change  in  the  cartil- 
ages may  commence  as  early  as  the  first  week  of  the  Laminitis, 
and  although  the  trouble  in  the  laminae  is  removed  in  the  course 
of  a  fortnight,  the  symptoms  do  not  entirely  Subside,  the  ani- 
mal still  retaining  the  shuffling  gait,  while  the  side  bones  con- 
tinue to  grow,  and  the  patient  usually  remains  quite  lame. 
This  alteration  of  the  cartilages  generally  prevents  the  patient 
recovering  his  natural  gait,  because  of  the  permanent  impair- 
ment of  function  induced,  and  the  practitioner-  receives  unjust 
censure  for  a  condition  of  affairs  he  could  neither  fore-see  nor 
prevent. 

The  lamanitic  process  also  occasionally  extends  to  the 
periosteum  of  the  os  coronae  ;  or  at  least,  concurrent  with  and 
subsequent  to  Laminitis  the  development  of  "  low  ring-bone  " 
is  seen,  and  it  is  apparently  dependent  upon  the  disease  of  the 
laminae  for  its  exciting  cause.  The  impairment  of  function  and 
consequent  symptoms  are  much  less  marked  here  than  in  side- 
bones.  The  coronet  remains  hot  and  sensitive,  and  somewhat 
thickened  after  the  Laminitis  subsides,  and  a  little  lameness  is 
present.  This  lameness  persists  and  the  deposits  of  new  bone 
may  readily  be  detected. 


LAMINITIS.  21 


Suppuration. 


Suppuration  of  the  keratogenous  membrane  is  a  somewhat 
common  compHcation,  and  even  when  present  in  its  most 
limited  form  is  always  a  serious  matter  ;  but  when  it  becomes 
extensive,  and  especially  where  the  suppurative  process  extends 
to  the  periosteum,  the  results  are  apt  to  be  fatal.  When  sup- 
puration occurs  the  exudation  does  not  appear  to  be  excessive, 
but  is  rich  in  leucocytes,  and  seems  to  have  caused  a  detach- 
ment of  the  sensitive  tissues  from  the  horn,  prior  to  the  forma- 
tion of  pus  in  some  instances,  while  in  others  the  tissues  are 
still  attached  to  the  horn,  and  the  suppuration  takes  place  in 
the  deeper  tissues. 

Limited  suppurations  may  take  place  in  any  part  of  the 
sensitive  tissues  of  the  foot  during  Laminitis,  and  may  ulti- 
mately be  reabsorbed  instead  of  being  discharged  upon  the  sur- 
face ;  but  generally  the  process  begins  in  the  neighborhood  of 
the  toe,  and  spreads  backwards  and  upwards  towards  the  coro- 
net, where  it  is  seen  separating  the  horn  from  the  coronary 
band  at  the  quarters.  At  the  same  time  it  is  spreading  over 
the  sole,  and  eventually  the  entire  hoof  is  loosened,  and  finally 
sloughs  away,  leaving  the  tissues  beneath  entirely  unprotected. 
If  an  examination  of  the  keratogenous  membrane  is  now  care- 
fully made,  it  will  be  found  covered  in  greater  part  by  pus  and 
coagulated  exudate;  at  some  points  newly-organized  horn  may 
be  seen,  while  in  others,  and  especially  in  the  recently  separated 
portions,  extravasated  blood  intermingles  with  the  pus. 

In  other  instances,  and  these  are  generally  the  cases  not 
considered  unusually  severe,  the  suppuration  begins  at  the  cor- 
onary band  which  we  find  greatly  effused,  and  crowded  with 
wandering  cells  and  leucocytes.  The  suppuration  extends  but 
a  short  distance  in  the  podophyllous  tissue,  yet  serves  to  de- 
stroy the  patient  by  separating  the  hcof  from  the  coronary  band 
upon  which  it  depends  for  support  and  growth.  In  this  form 
of  the  suppurative  process,  it  is  usually  seen  beginning  in  front  ; 
for  it  is  this  part  of  the  coronary  band  that  is  always  most  ac- 
tively affected  with  inflammation,  and  consequently  it  is  here 
that    impairments    first  occur.      Suppuration    of   the    sensitive 


22  LAMINITIS. 

sole,  is  more  common  than  of  the  sensitive  laminae  and  coron- 
ary band.  It  is  present,  in  the  majority  of  cases,  where  there  is 
a  dropping  of  the  os  pedis,  and  in  other  instances  where  the 
effusion  at  this  point  is  so  great  as  to  arrest  the  production  of 
horn  and  uncover  the  sensitive  tissues.  Except  when  the  result 
of  injury,  it  begins  at  the  toe  and  spreads  backward,  and  if  not 
relieved  by  opening  the  sole,  escapes  at  the  heel.  Suppuration 
of  the  sole  is  much  less  serious  than  where  present  in  other 
parts  of  the  foot. 

If  the  acute  constitutional  symptoms  developed  from  this 
sloughing  of  the  foot  do  not  result  in  death,  a  new  hoof  of  very 
imperfect  horn  may  be  developed  after  a  time,  but  unless  the 
animal  is  to  be  kept  for  breeding  purposes  alone,  the  foot  will 
ever  be  useless  for  work,  and  death  should  relieve  the  suffering. 
When  only  the  sole  sloughs,  recovery  takes  place  with  proper 

treatment. 

Peditis. 

This  is  the  term  which  Williams  applies  to  that  serious 
complication  of  Laminitis  where  not  only  the  laminae,  but 
the  periosteum  and  the  pedal  bone  are  also  the  subjects  of 
the  inflammatory  process.  Neither  is  this  all,  for  in  some  of 
these  cases  of  peditis  acute  serous  synovitis  of  the  "  coffin 
joint,"  is  present,  and  where  the  tendency  is  to  suppuration  em- 
pyema of  the  joint.  Where  periostitis  and  ostitis  complicate 
Laminitis,  the  exudation  takes  place  in  the  keratogenous  mem- 
brane in  and  beneath  the  periosteum,  and  in  the  bone  tissue.  A 
mild  form  of  periostitis,  in  which  the  exudation  is  in  the  outer 
or  looser  layer  of  the  periosteum  only,  is  a  more  common  con- 
dition than  is  recognized  by  practitioners  generally  ;  and  the 
intimate  contiquity  of  structures  is  the  predisposing  cause,  the 
disease  either  spreading  from  the  original  seat,  or  the  compli- 
cation occurs  as  one  of  the  primary  results  of  the  exciting  cause. 
In  the  severer  cases  where  the  exudate  separates  the  perios- 
teum from  the  bone,  suppuration,  gangrene,  and  superficial 
caries  are  common  results.  Where  the  plastic  infiltration  of 
the  bone  tissue  is  rapid,  the  blood  supply  is  cut  off  by  the  con- 
sequent pressure  upon  the  vessels  in  the  Haversian  canals,  and 
necrosis  of  the  os  pedis  ensues.    Grave  constitutional  symptoms 


LAMINITIS.  23 

mark  these  changes,  and  soon  prove  fatally  exhaustive  to  the 
patient. 

In  the  mild  cases  of  Periostitis  it  is  by  no  means  easy  to 
determine  its  presence  positively,  for  there  are  no  special  symp- 
toms by  which  it  may  be  distinguished  from  pure  Laminitis. 
In  the  majority  of  the  acute  cases,  though,  that  show  no  signs 
of  improvement  by  the  fifth  to  seventh  day,  it  is  safe  to  sus- 
pect periostitis  is  present,  particularly  if  the  coronets  are  very 
hot,  the  pulse  remaining  full  and  hard,  and  the  lameness  acute. 
In  the  fortunately  rare  cases  where  the  bone  is  affected  with 
inflammation  and  suppuration,  the  agony  of  the  patient  is  in- 
tense, he  occupies  the  recumbent  position  almost  continually, 
never  standing  for  more  than  a  few  minutes  at  a  time,  suffers 
from  the  most  careful  handling  of  the  affected  feet,  maintains 
a  rapid  pulse  and  respirations,  high  temperature,  loss  of  appe- 
tite and  great  thirst.  It  is  in  these  cases  the  patient  continu- 
ally grows  worse,  and  the  appearance  of  suppuration  at  the 
top  of  the  hoof  in  about  two  weeks  after  the  inception  of  the 
disease,  proves  the  inefficiency  of  any  treatment  that  may  have 
been  adopted,  and  the  hopelessness  of  the  case.  These  pa- 
tients die  usually  between  the  tenth  and  twentieth  days, 
either  from  exhaustion  or  pyaemic  infection.  In  making  post- 
mortem examinations  of  this  condition,  the  os  pedis  will  be 
found  blocked  in  parts  with  the  exudate  thrown  out  from  its 
numerous  blood  vessels.  There  is  atrophy  of  the  bony  tissue 
surrounding  the  Haversian  canals,  and  a  development  of  con- 
nective tissue  within,  or  else  the  enlarged  canal  is  filled  with 
suppuration.  The  contiguous  surface  is  denuded  of  its  perios- 
teum, which  has  been  detached  by  the  free  exudation,  is  darker 
In  color  than  the  healthy  bone  and  generally  roughened. 

Caries. 

Superficial  caries  may  be  present  in,  or  follow,  any  case 
of  Laminitis,  and  its  most  common  seats  are  directly  at  the 
toe,  particularly  at  the  anterior  surface,  upon  the  anterior 
face  just  beneath  the  pyramidal  process,  and  on  the  plan- 
tar surface  of  the  relrossal  processes.  In  this  last-named 
position  it  occasionally  becomes  more  than  superficial,  extend" 


24  LAMINITIS. 

ing  deep  into  the  bone  which  it  honey-combs  completely  in 
the  adjacent  parts,  and  finally  destroys,  so  that  this  part 
of  the  bone  may  be  found  crumbling  to  pieces  on  attempting 
to  remove  it. 

Gangrene, 

Occurs  in  the  periosteum  as  the  result  of  excessive  detach- 
ment from  the  bone,  combined  with  compression  from  an  over- 
profuse  exudate.  Other  parts  of  the  sensitive  tissues  are  sub- 
ject to  the  same  fate  occasionally,  from  this  last-named  cause, 
and  at  times  large  territories  will  be  found  dead. 

Fuiniced  Sole, 

Is  that  condition  in  which  the  horny  sole  in  the  neighbor- 
hood of  the  toe  readily  crumbles  away  and  leaves  the  sensitive 
tissues  more  or  less  exposed.  It  is  not  confined  to  being  a 
complication  of  Laminitis,  but  may  be  seen  whenever  the  ne- 
cessary conditions  for  inducing  it  are  present.  Williams  has 
described  the  horny  tissue  under  these  circumstances  as  being  : 
"  weak,  cheesy,  ar  spongy,  like  macerated  horn,  or  even  grum- 
ous,"  and  this  certainly  conveys  a  good  idea  of  its  appearance 
and  general  characteristics.  This  crumbling  horn  when  critic- 
ally examined,  shows  almost  an  entire  absence  of  the  cohesive 
matter  which  unites  the  healthy  horn  fibres,  while  the  fibres 
themselves  are  irregular  and  granular  in  appearance.  Pumiced 
sole  depends  upon  an  impairment  of  the  horn-secreting  powers 
of  the  sensitive  sole,  or  upon  a  separation  occurring  between 
the  horny  and  soft  tissues  which  maintain  its  vitality.  The 
normal  sole  physiologically  maintains  a  proper  thinness,  by 
crumbling  off  in  scales  as  it  passes  beyound  the.  life-mataining 
influence  of  the  producing  tissues,  and  anything  which  perverts, 
suspends,  or  destioys  this  inflluence,  causes  the  crumbling  pro- 
cess to  become  excessive. 

Punctured  wounds  of  the  feet,  where  accompanied  by  any 
considerable  destruction  of  the  soft  or  horn-secreting  tissues, 
present  the  same  peculiarities  in  this  respect,  in  the  immediate 
neighborhood  of  the  injury.  Bruises  of  the  sole  are  occasion- 
ally followed  by  this  change  in  the  horn,  where  the  exudation 
has  been   excessive  and  separated  it  from   the    living    tissues. 


LAMINITIS.  25 

True  in  these  cases  we  rarely  see  the  soft  tissues  laid  bare  for 
the  reason  that  new  horn  is  constantly  secreted  and  replaces 
that  undergoing  the  process  of  disintegration. 

Laminitis  presents  three  different  conditions  under  which 
pumiced  sole  may  appear.  First :  where  free  exudation  separ- 
ates the  horn  from  the  other  tissues,  or  where  the  process  of 
inflammation  arrests  the  production  of  horn,  by  impairing  or 
destroying  the  horn-secreting  membrane.  Secondly  :  where 
depression  of  the  os  pedis  causes  pressure  upon,  and  arrests  the 
formation  of  horn  ;  and,  Thirdly  ;  where  the  elevation  of  the 
sole  compresses  the  soft  tissues  against  the  pedal  bone  and  in- 
duces the  same  condition.  Pumiced  sole  as  it  results  from 
simple  exudation  and  separation  of  tissues  is  of  no  importance, 
for  the  reason  given  above  in  connection  with  bruises  ;  but 
where  suppuration  occurs  in  restricted  portions  of  the  foot  in 
conjunction  with  Laminitis,  it  always  lays  bare  the  tissues  be- 
neath and  impairs  the  animal's  value  temporarily.  In  these 
cases  recovery  takes  place  after  a  few  weeks  time  by  the  tis- 
sues horning  over,  as  in  injuries  which  have  been  attended  with 
the  same  process.  Depression  of  the  os  pedis  is  not  a  sufficient 
cause  within  itself  to  cause  pumiced  sole  ;  for,  if  the  relative 
change  in  the  bone  takes  place  slowly,  or  if  the  horn  is  thin, 
the  sole  becomes  convex  from  the  gradual  pressure,  and  the  soft 
tissues  adapt  themselves  to  the  change  without  having  their 
function  materially  impaired.  But  when  the  dropping  is  sud- 
den and  the  soft  tissues  entirely  destroyed,  the  horn  rapidly 
crumbles  away  and  the  toe  of  the  bone  comes  through.  In 
many  of  these  cases  the  soft  tissues  remain  uncovered  for 
months,  and  when  they  eventually  become  covered,  it  is  with 
a  thin  slightly  adherent  horn  that  bears  but  little  or  no  wear. 
The  sole  being  now  convex,  the  diseased  tissues  are  compelled 
to  bear  unusual  weight  by  coming  in  contact  with  the  ground, 
and  hence  it  is  these  animals  are  generally  incurable  cripples. 
In  the  majority  of  cases  where  the  sole  is  raised  to  meet  the 
pedal  bone,  and  pumiced  sole  occurs,  it  is  due,  not  to  pressure 
of  the  bone  from  within,  (for  the  tissues  are  capable  of  adapt- 
ing themselves  to  the  gradual  change)  but  to  impaired  vitality 
of  the  sensitive  tissues  from  the  inflammation,  and  the  constant 


26  LAMINITIS. 

concussion  and  pressure  applied  from  without  during  progres- 
sion. Added  to  this  is  to  be  considered  the  paring  away  of  the 
horn  by  the  smith  when  applying  the  shoe,  thereby  keeping 
the  sole  at  this  point  too  thin. 

Turning    Up  of  The   Toe. 

The  results  of  my  investigation  into  the  cause  and  pathol- 
ogy of  this,  too  frequent,  and  most  interesting  sequel  of  Lam- 
initis  are  somewhat  at  variance  with  the  explanations  given  by 
previous  writers  on  the  subject.  For  instance,  Prof  Williams 
in  his  "  Surgery"  says  :  ''  In  some  cases  the  removal  of  the  ex- 
udate leaves  a  space  between  the  sensitive  and  horny  laminae, 
which  has  led  some  observers  to  think  that  the  disease  consists 
essentially  of  absorption  of  the  bond  of  union  between  the  two 
sets  of  laminae,  the  formation  of  a  cavity  and  the  subsequent 
filling  up  of  it  with  imperfect  cheesy  or  seedy  horn  constituting 
what  is  termed  seedy-toe.  Should  the  inflammation  persist, 
the  exudate  accumulates  at  the  toe,  increases  in  thickness, 
presses  upon  the  toe  of  the  os  pedis  in  the  one  direction,  and 
upon  the  crust  in  the  other,  separating  the  two,  forcing  the 
toe  of  the  bone  downwards,  and  the  toe  of  the  crust  upwards. 
The  effect  of  this  change  in  the  position  of  the  bone  is  the 
formation  of  a  convex  sole."  Prof  Law  in  his  "Adviser'' 
makes  the  following  remarks  in  relation  to  this  condition  :  "  If 
the  inflammation  persists  in  a  slight  form,  an  excessive  growth 
of  soft  spongy  horn  takes  place  in  front  of  the  laminae  at  the 
toe,  separating  the  coffin  bone  from  the  hoof-wall,  and  allow- 
ing its  anterior  border  to  press  upon  the  sole,  or  even  to  per- 
forate it."  That  "the  removal  of  the  exudate  leaves  a  space 
between  the  sensitive  and  horny  laminae  "  is  not  clear  to  me, 
for  I  have  never  been  able  to  find  an  empty  space  between  the 
laminae,  no  matter  how  far  apart  they  may  have  been  forced. 
It  does  not  seem  possible  that  such  a  condition  could  in  any 
way  be  produced  by  resorption,  for  the  opposition  to  be  over- 
come in  order  to  produce  an  empty  space,  a  vacuum — is  much 
greater  than  can  be  accomplished  by  the  absorbents. 

All  reabsorption  of  effused    material   must  be  followed  in 
subcutaneous   parts,  by  one  or  more  of  four   conditions  :   con- 


LAMINITIS.  27 

traction  of  tissue,  renewed  effusion,  replacement  of  displaced 
parts,  or  the  production  of  ne^v  tissue. 

So  far  as  my  observations  have  gone,  I  find  the  effusion 
under  all  circumstances  in  Laminitis  comparatively  limited, 
and,  that  as  the  effused  material  is  absorbed,  the  parts  regain 
their  normal  position  and  condition,  or  else  the  exudate  is  re- 
placed by,  or  converted  into  ,  new  tissue — so  that  at  no  time 
is  there  an  empty  space  created  in  the  structures  of  the  foot. 
No  matter  how  severe  the  inflammatory  action  may  be,  nor 
how  profuse  the  exudation,  unless  suppuration  occurs,  the  soft 
tissues  are  not  destroyed  to  any  considerable  extent. 

It  is  claimed  by  some  writers  that  the  soft  tissues,  having 
been  separated  by  the  exudate  from  the  horn,  have  lost  their 
function  ;  and  that  new  horn,  formed  so  plenteously  under  cer- 
tain conditions,  is  produced  alone  by  the  coronary  band.  We 
deny  that  this  is  true  ;  for  we  nnd  in  all  of  these  cases,  where 
there  is  turning  up  of  the  toe,  that  the  horn-producing  lunction 
of  the  coronary  band  is  greatly  impaired — in  some  cases  almost 
entirely  suspended,  upon  the  anterior  part  of  the  foot,  and  that 
the  greater  this  impairment  on  the  part  of  the  coronary  band 
the  richer  is  the  production  of  new  horn  at  the  toe.  Further- 
more, the  new  horn  is  always  intimately  attached  to  the  podo- 
phyllous  tissue  beneath,  by  which  it  has  unquestionably  been 
produced;  for  if  the  coronary  band  is  producing  but  little,  and 
the  old  horn  is  but  slowly  growing  off,  whence  comes  this  new 
horn  }  It  cannot  come  from  a  tissue  which  can  only  replace 
old  horn  with  new,  the  said  tissue  being  at  least  two  inches 
away  from  the  point  of  production.  Another  evidence  that 
the  new  horn  comes  from  the  podophyllous  tissue,  is,  that  when 
the  function  of  the  coronary  band  is  regained,  (as  it  oftimes  is), 
this  new  horn  grows  off  with  the  wall  and  is  replaced  by  new 
horn  from  above,  or  from  the  coronary  band. 

Furthermore,  this  new  horn  is  arranged  between  the  sen- 
sitive laminae  in  plates  similar  co  the  arrangement  of  the  horny 
laminae  in  the  normal  foot,  with  the  exception  that  they  are 
not  quite  so  regular  and  perfect  in  outline,  and  are  covered 
with  more  of  the  free  cells  spoken  of  by  Fleming.  Regarding 
the  direction  of  the  horny  fibres  in  this  new  horn,  they  will  be 


28  LAMINITIS. 

found  more  oblique  than  the  fibres  in  the  healthy  wall,  the  pro- 
ducing tissue  seeming  to  endeavor  to  throw  these  fibres  off  at 
somewhat  an  approach  to  a  right  angle,  as  seen  in  the  sensitive 
sole  and  coronary  band.  Lastly  these  fibres  are  somewhat 
flexuous,  as  in  the  healthy  frog. 

At  whatever  time,  during  the  progress  of  the  disease,  the 
separation  of  the  sensitive  and  horny  tissues  is  effected,  the  os 
pedis  thereafter  tends  to  alter  its  relative  position  by  reason  of 
the  weight  which  it  receives,  and  the  position  the  animal  as- 
sumes  throwing  all  the  strain  on  the  flexors. 

But  this  tendency  amounts  to  nothing  of  importance,  unless 
there  is  extensive  separation  of  the  bonds  of  union,  when  the 
consequent  pressure  upon  the  soft  tisses  of  the  sole,  already 
impaired  by  disease,  proves  disastrous  to  their  horn-producing 
function,  and  ultimately  destroys  their  structure.  As  seen  in 
plate  No.  2,  this  deviation  of  the  os  pedis  amounts  to  about  five 
lines,  the  convexity  of  the  sole,  reaching  four  and  a  half  lines. 
Here  the  change  has  been  so  gradual  that  but  little  impairment 
of  the  function  of  the  sensitive  sole  has  resulted  ;  and  the  thin- 
ness of  the  horny  sole  in  front  of  the  frog,  is  due  to  the  interfer- 
ence of  the  shoeing-smith.  The  space  between  the  toe  of  the  os 
pedis  and  the  original  horn-wall,  has  been  filled  in  with  new  horn, 
as  the  bone  receded  from  its  original  position.  If  this  change  in 
the  relation  of  the  bone  to  the  other  tissues,  was  due,  as  Wil- 
liams claims,  to  pressure  of  the  exudate,  this  pressure,  to  over- 
come the  opposition  of  the  sole,  etc.,  would  be  so  powerful  as  to 
impair  the  horn-secreting  function  of  the  podophyllous  tissue 
on  the  anterior  toe  of  the  os  pedis  ;  and  hence,  we  would  find 
but  little  horn  secreted,  and  that  of  a  very  inferior  quality. 
The  opposite  are  the  facts — plenty  of  horn  of  a  good  quality. 
That  replacement,  complete  or  in  part,  takes  place  in  many  of 
these  cases,  cannot  be  denied,  for,  as  the  superfluous  horn  at  the 
toe  grows  off  with  the  wall,  the  bone  tends  to  resume  its  old 
position. 

The  exudate  plays  no  part  whatsoever  \w  forcing  the  toe  of 
the  OS  pedis  downward,  and  the  toe  of  the  hoof  upward,  as 
claimed  by  Williams  and  Law. 

It  does  not  always  even  so  much  as  cause  the  separation  be- 


LAMINITIS.  29 

tween  the  sensitive  and  horny  tissues  ;  for  at  times  this  so- 
lution of  continuity  is  dependent  upon  other  causes  which  have 
no  connexion  with  exudation.  The  turning  up  of  the  toe,  as 
seen  in  plate  No.  3,  is  only  the  result  of  a  simple  mechanical 
principle  brought  into  operation  by  means  of  the  altered  rela- 
tive growth  of  the  horny  fibres  in  different  parts  of  the  foot. 

In  every  one  of  these  cases  there  is  a  very  decided  impair- 
ment of  horn  production  upon  the  part  of  the  coronary  band 
in  its  anterior  part,  while  at  the  heel  the  production  is  as  rapid, 
or  even  takes  place  more  rapidly,  than  normal,  and  the  inevit- 
able result  is  the  formation  of  an  angle  upon  the  anterior  wall  ; 
for  the  gro-A'ing  heel  tends  to  revolve,  in  its  growth,  around  the 
fixed  point  near  the  cornary  band.  As  the  angle  forms  at  the 
point  where  the  impairment  of  function  exists,  /.  e.,  near  the 
coronary  band,  the  horn-fibres  are  deflected  forwards,  and  con- 
sequently upwards,  so  that  the  toe  is  brought  nearer  the  horizon- 
tal line,  and  the  angle  formed  by  the  bones  of  the  leg  with 
the  anterior  wall  of  the  foot  is  diminished.  This  turning  up  of 
the  toe  does  not  take  place  suddenly,  as  it  might  if  dependent 
upon  the  pressure  of  exudation,  but  the  change  is  effected  slow- 
ly, and  is  commensurate  only  with  the  proportionate  impair- 
ment of  horn  secretion  in  front,  and  normal  or  increased  produc- 
tion at  the  heel.  If  the  secretion  of  horn  is  nowhere  impaired, 
or  if  the  interference  with  this  function  is  equally  distributed 
throughout  the  entire  coronary  band,  then  it  matters  not  what 
amount  of  exudation  may  take  place  over  the  toe  of  the  os 
pedis,  tlie  toe  of  horn  does  not  and  cannot  turn  up. 

But  when  the  necessary  causes  are  in  operation,  and  the 
angle  begins  to  form  on  the  anterior  wall,  the  toe  of  the  os 
pedis,  with  its  soft  tissues  attached,  is  separated  from  the  horny 
laminae,  and  becomes  pressed  upon  by  the  upraising  sole.  This 
separation  of  the  tissues  is  due  to  the  fact  that  the  action  of  the 
flexor  pedis  perforans  and  the  ligaments  of  the  "  coffin  joint " 
tend  strongly  to  hold  the  os  pedis  in  its  normal  position,  in  re- 
lation to  the  other  bones  of  the  leg  ;  while  the  strongest  oppo- 
sition is  offered  to  the  toe  accompanying  the  horn,  by  the  artic- 
ular base  of  the  coffin  bone,  and  especially  the  pyramidal  em- 
inence, being  situated  above  the  point  of  the  new  angle,  there- 


30  LAMINITIS. 

b}'  necessitating  the  downward  movement  of  all  this  part  of  the 
bone  so  that  the  toe  might  conform  to  the  new  line  of  angular- 
ity assumed  by  the  lower  anterior  wall  of  the  hoof*  The  exu- 
dation which  is  now  found  taking  place  at  the  toe  is  the  result, 
not  the  cause,  of  the  separation  of  the  sensitive  from  the  non- 
sensitive  tissues,  and  the  new  horn,  which  forms  here,  is  the  pro- 
duct of  the  neighboring  podophyllous  tissue. 

As  the  toe  of  the  horny  box  proceeds  in  its  change  of  re- 
lative position,  the  sole  rises  to  the  os  pedis,  which  eventually, 
by  its  pressure,  causes  convexit}^  of  the  horny  sole. 

Animals  affected  with  pumiced  foot,  and  turning  up  of  the 
toe,  during  progression,  always  place  the  abnormally-long  heel 
first  upon  the  ground,  not  because  the  heel  is  too  long  nor,  as 
in  acute  or  sub-acute  Laminitis,  to  relieve  the  pain,  but  for  the 
simple  reason  that  the  animal  carries  the  leg  forward  with  the 
column  of  bones  in  the  normal  position,  and  attempting  to  keep 
them  so,  the  heel  first  comes  in  contact  with  the  ground,  and 
he  then  knuckles  over  at  the  fetlock,  in  proportion  to  the  a- 
mount  of  foot  deformity  present,  as  he  brings  the  toe  to  the  sur- 
face. 

The  pain  and  impairment  of  function  in  these  cases  always 
results  in  marked  atrophy  of  the  muscles  of  the  fore-arm,  shoul- 
der, and  to  some  extent  of  the  pectorals,  while  the  position  of 
the  fore  feet  advances  the  scapulo-humeral  joints  so  well  for- 
ward as  to  cause  a  somewhat  sunken  appearance  of  the  chest 
in  front,  which  the  laity  recognize  as  a  peculiar  form  of  the  dis- 
ease which  they  have  designated  as  "Chest  Founder." 

Regarding  the  presence  of  inflammation  during  this  process, 
there  is  no  doubt  a  chronic  form  is  in  existence  a  long  time  after 
these  lesions  commence,  yet  it  may  in  time  subside  and  leave 
the  feet  free  from  fever  while  the  other  changes  still  go  on. 

The  lesions  of  turning  up  of  the  toe  are  permanent,  and  are 
withal,  the  most  interesting,  pathologically,  of  all  the  compli- 
cations of  Laminitis. 


*  Since  writing  the  above,  I  have  seen  a  case  in  whicli  the  angle  formed  directly 
at  the  coronary  band,  the  os  pedis  being  carried  up,  at  the  toe,  with  the  horn,  \\hile 
the  articular  base  was  correspondingly  depressed.  The  sole  was  of  the  normal  thick- 
ness, and  not  in  the  least  convex. 


LAMTNITIS. 

Erosions  of  Encrusting  Cartilage. 

The  altered  position  of  the  os  pedis,  as  related  tolffe-^eight- 
bearing-  surface,  is  such  that  in  time,  the  flexors  are  shdH,erie<3, 
and  the  joints  become  permarently  sub-luxated  with  accofit-  ■ 
panying  degenerative  process  of  the  articular  surfaces  which 
end  in  large  ulcers  at  the  fetlock,  the  second,  and  sometimes 
the  third,  phalangeal  articulations.  These  diseased  conditions 
of  the  joints,  add  to  the  suffering  of  the  animal  and  increase  his 
difficulty  of  locomotion. 

TREATMENT. 

The  treatment  of  Laminitis  is  probably  more  varied  than 
in  any  other  disease,  and  yet  in  spite  of  it  a  large  number  of 
cases  recover  for  even  the  poorest  practitioner.  Since  there 
are  two  objects  to  be  attained  in  treatment — prevention  and 
remedy — the  matter  will  be  considered  under  the  head  of  pro- 
phylaxis and  remedial  medication. 

Prophylaxis. 

To  guard  against  and  prevent  disease,  or  to  render  an  un- 
preventable  attack  less  serious  than  it  otherwise  would  be,  is 
the  highest  practice  of  the  healing  art.  In  a  disease  so  prone 
to  result  from  the  simplest  causes,  as  seen  in  Laminitis,  and 
especially  when  the  soundest  judgment  may  not  be  able  to 
determine  the  extent  of  the  disease-resisting  powers  of  the 
tissues  which  are  liable  to  be  affected,  or  of  what  shall  in  every 
instance  constitute  an  over-excitement,  it  is  not  strange  that 
authors  have  avoided  this  field  of  instruction,  and  that  horse- 
owners  find  themselves  in  trouble  from  unintentional  transgres- 
sion. If  the  disease  was  dependent  upon  specific  causes,  or  if 
the  stability  of  the  tissues  was  of  a  fixed  or  more  nearly  deter- 
minate quality,  some  measures  might  be  instituted  that  would 
prove  generally  preventive.  But  when  we  recall  the  fact  that 
predisposing  causes  are  so  prevalent,  and  often  cannot  be  rem- 
edied ;  that  what  is  but  gentle  work  in  one  instance  may  incite 
disease  in  another  ;  that  what  is  food  to-day  may  to-morrow 
prove   disastrous  to  health,  and  that    necessary  medical   inter- 


32  LAMINITIS. 

ference,  no  matter  how  judicious,  may  cause  a  more  serious 
complaint  than  that  which  was  being  treated,  the  obstacles  to 
contend  with  become  plain.  Notwithstanding  the  difficulties 
besetting  effective  prophylaxis  of  this  disease,  there  are  some 
general  rules  to  be  observed  that  will  in  part  serve  to  prevent 
the  dev^elopment  of  an  unusual  number  of  cases.  In  the  first 
place,  all  the  predisposing  causes  named,  must  be  removed 
where  possible,  and  when  this  is  impossible,  unusual  care  must 
be  taken  not  to  bring  into  operation  an  exciting  cause.  Fat 
animals  should  under  no  circumstances  have  hard  work,  and  if 
the  weather  is  warm,  or  the  variation  of  temperature  great, 
they  should  have  but  slozv,  gentle  labor,  until  they  become  in- 
ured to  it,  the  tissues  hardened,  and  their  excitability  reduced 
to  a  minimum. 

Green  horses  should  always  have  moderate  work  for  the 
same  reason,  and  particularly  when  changed  from  the  farm  and 
dirt-roads  to  city  pavements.  The  increased  concussion,  changed 
hygienic  conditions  and  artificial  living  readily  become  active 
causes  of  the  disease  under  these  circumstances. 

Army  horses  just  out  of  winter-quarters,  track-horses  with 
insufficient  preparation,  and  farmer's  horses  put  to  work  in  the 
Spring,  are  among  the  most  susceptible  classes,  and  must  be 
protected  by  work  that  is  easy  and  gradual.  If  long  marches 
or  drives  are  imperative,  then  the  incumbrances  must  be  as 
light  as  possible,  and  the  journey  interspersed  with  frequent 
rests  ;  for  this  allows  the  laminae  to  regain  their  impaired  func- 
tional activity,  and  thereby  to  withstand  much  more  work 
without  danger.  And,  furthermore,  it  permits  an  early  detec- 
tion of  an  oncoming  attack  m  any  case,  prevents  working  after 
the  disease  begins  and  renders  subsequent  medication  much 
more  effective  by  cutting  the  process  siiort  at  the  stage  of  con- 
gestion. 

All  animals  when  resting  immediately  after  work,  should 
be  protected  from  cold  air  or  draughts.  If  placed  in  a  stable 
that  is  warm  and  without  draught,  no  covering  is  necessary — 
under  opposite  conditions  blankets  should  be  used  until  the 
excitement  and  exhaustion  of  the  labor  performed  have  entirely 
passed  away.     It  is  still  better  that  all  animals  coming  in  warm 


LAMINITIS.  3"3 

from  work,  be  "cooled  out"  by  slow  walking  until  the  perspir- 
ation has  dried,  and  the  circulation  and  respiration  returned  to 
the  normal.  Animals  stopped  on  the  road,  even  for  a  few 
moments'  time,  should  always  be  protected  from  rapid  change 
of  temperature  by  appropriate  clothing.  If  it  can  be  avoided, 
horses  that  are  working  should  never  be  driven  or  ridden 
through  a  stream  or  pool  of  water.  Where  necessary,  they 
should  be  cooled  off  before  passing  through,  and  then  kept  ex- 
ercising until  completely  dried.  The  same  rule  is  to  be  ob- 
served with  regards  washing  the  legs  in  cold  water,  when  the 
animal  is  just  in  from  work  ;  for  although  it  is  practiced  exten- 
sively and  usually  with  impunity,  occasionally  it  proves  the 
cause  of  a  most  acute  attack  of  this  disease.  Regarding  shoe- 
ing, as  a  predisposing  cause,  unusual  changes  in  the  manner 
of  applying  the  shoe  should  not  be  hastily  made. 

If  a  plain  shoe  has  been  worn,  high  heels  or  toes  must  not 
be  substituted  at  once,  but  the  change,  if  necessary,  gradually 
made,  so  that  the  different  tissues  may  adapt  themselves  to 
the  change  of  functional  performance  they  are  called  upon  to 
bear.  If  on  the  other  hand  such  changes  are  imperative,  as  is 
sometimes  the  case,  then  the  work  must  be  so  reduced  in  quan- 
tity and  quality  that  it  cannot  prove  excitant  of  the  disease. 
Laminitis  from  the  effects  of  purgative  medicines  is  a  condition 
which  can  scarce  be  effectively  guarded  against,  unless  we  dis- 
card entirely  this  useful  class  of  medicines.  I  cannot  deter- 
mine from  the  few  cases  in  which  I  have  seen  this  unhappy  re- 
sult of  a  purgative,  that  there  are  any  conditions  of  the  system 
present  that  would  warn  us  of  danger  in  this  direction.  The 
disease  does  not  seem  to  have  any  dependence,  for  inception,  in 
such  cases  upon  the  size  of  the  purgative,  the  length  of  time 
before  purgation  begins,  or  the  activity  and  severity  with  which 
the  remedy  acts.  The  extent  of  prophylaxis  in  this  regard, 
must  be  confined  to  the  exhibition  of  moderate  doses  of  medi- 
cines known  to  have  .unusual  irritating  effects  on  the  alimen- 
tary canal.  They  should  be  used  only  when  necessity  de- 
mands it. 

Experience  alone  will  determine  what  animals  are  liable 
to  suffer  from  this  disease  tln-ousfh  tne  influence  of  the  different 


34  LAMINITIS. 

aliments.  When  an  attack  can  with  any  certainty  be  ascribed 
to  any  particular  food,  it  should  ever  be  withheld  unless  in  the 
smallest  quantities.  Horses  that  have  never  been  fed  upon 
Indian  Corn,  should  receive  but  a  little  at  a  time  at  first, 
and  always  mixed  with  bran,  oats  or  other  food,  until  it  has 
been  determined  that  no  danger  exists.  Corn  is  much  more 
liable  to  cause  Laminitis  in  warm  than  in  cold  weather,  and  for 
this  reason  it  should  always  be  fed  with  care  during  Spring 
and  Summer  months.  Against  Metastatic  Laminitis  there  are 
no  measures  which  can  in  any  way  prove-  preventive,  the  im- 
portant consideration  being  its  early  recognition,  which  is  more 
readily  accomplished  than  in  Metastatic  Pneumonia  concurrent 
with  Laminitis.* 

When  an  animal  is  excessively  lame  in  one  foot,  the  other 
or  opposite  member  should  have  the  shoe  early  removed,  and 
cold  water  frequently  applied.  At  the  same  time  the  slings 
should  be  used  if  the  subject  remains  standing.  Horses  should 
under  no  circumstances  be  over-worked  :  to  guard  against  this 
previous  work,  nature  of  roads,  state  of  weather,  and  various 
other  influences  must  be  carefully  noted.  Watering  while 
warm,  is  a  pernicious  habit,  and  unless  the  animal  is  accus- 
tomed to  it,  is  apt  to  result  in  some  disorder — oftimes  in 
Laminitis. 

Remedial  Medication. 

In  those  .cases  of  simple  passive  congestion  of  the  laminae 
the  body  should  be  warmly  clothed,  and  warm  drinks  given  to 
draw  the  blood  in  increased  quantity  to  these  parts,  -so  as 
to  direct  it  from  the  feet  ;  at  the  same  time  the  feet  should  be 
placed  in  warm  water  so  as  to  increase  the  return  flow  of  blood. 
In  the  course  of  half  an  hour  the  feet  may  be  changed  to  cold 
water,  which  serves  as  a  tonic  to  all  the  tissues,  and  kept  there 
until  recovery  is  completed.  If  the  constitutional  symptoms 
demand  it  diuretics  should  be  given.  Half-ounce  doses  of  nitre 
three  times  a  day  in  the  water  answers  the  purpose.  In  cases 
of  active  congestion  the  warm  foot-baths  should  be  omitted,  and 

*  I  have  omitted   speaking  of  Parturient  Laminitis,  never  having  seen  a  case, 
and  am  unacquainted  witli  appropriate  prophylaxis. 


LAMTNITIS.  35 

cold  ones  substituted  from  the  commencement.  Sub-acute 
Laminitis  demands  the  same  treatment,  with  laxatives  if  there 
is  constipation,  and  the  addition  of  low-heeled  shoes.  The 
diuretics  may  need  to  be  continued  for  some  tim'e,  and  their 
frequency  increased.  Regarding  Acute  Laminitis,  what  has 
been  called  the  "  American  Treatment "  is  so  simple,  and  withal 
so  efficient  that  it  is  to  be  remarked  other  countries  have  never 
adopted  it.  Since  the  disease  is  a  local  one,  unquestionably  the 
remedies  used  should  be  applied  in  the  immediate  neighborhood 
of  the  affected  parts,  or.  if  drugs  are  administered  internally, 
they  should  have  some  specific  localized  action. 

And  such  are  the  claims  made  for  the  above-named  meth- 
od of  treatment.  It  consists  solely  in  the  exhibition  of  large 
doses  of  Nitrate  of  Potash  and  the  continued  application  to  the 
feet  and  ankles,  of  cold  water.  We  have  never  been  able  to 
determine  that  nitre  had  any  action  on  the  keratogenous  mem- 
brane in  particular,  either  in  health  or  in  disease,  and  if  it  is  to 
be  called  a  specific,  the  claim  must,  as  yet,  rest  upon  the  fact 
that  it  nearly  always  cures.  One  noted  American  veterinary 
surgeon  attributes  its  good  results,  in  this  disease,  to  its  con- 
ceded power  of  defibrinizing  the  blood  ;  yet  if  this  were  its  only 
action,  an}^  remedy  producing  the  same  effect  in  the  same  de- 
gree, should  prove  just  as  effectual  as  a  remedy  ;  a  conclusion 
which  practice  does  not  sustain.  On  the  other  hand,  if  Nitre 
has  but  the  one  action  as  claimed,  the  remedies  inducing  the 
opposite  condition  would  be  contra-indicated;  yet  phlebotomy, 
which  is  known  to  favor  hyperinosis,  is  practiced  by  some  good 
practitioners  in  Laminitis,  and  as  they  claim,  with  the  best  of 
results.  But  be  its  action  what  it  may,  the  fact  remains  that 
three  to  fo7ir-ounce  doses  of  Nitre  repeated  every  six  hours 
is  attended  with  the  happiest  effects  ;  the  Laminitis  frequently 
subsiding  inside  of  a  week's  time.  ,  These  large  doses  may  be 
continued  for  a  week  or  ten  days'  time  without  danger  ;  never 
under  any  circumstances  have  I  seen  the  kidneys  irritated  to 
excess,  or  other  unfavorable  effects  produced. 

The  feet  should  either  be  kept  in  a  tub  of  water  at  a  tem- 
perature of  45'^  to  50^  F.;  (it  may  be  lowered  if  desired),  or  if 
the  animal  is  lying  down,  swabs  should  be  used   and  wet  every 


36  LAMINITTS. 

half  hour  with  the  cold  water.  The  water  not  only  keeps  the 
horn  soft  and  moist,  but  acts  directly  upon  the  inflamed  tissues 
by  reducing  their  temperature,  thereby  increasing  their  vitality 
and  disease-resisting  qualities,  and  at  the  same  time,  by  toning 
up  the  coats  of  the  blood  vessels,  diminishes  the  supply  of  blood 
and  limits  the  exudation.  Furthei^nore,  cold  has  also  an  an- 
set^thetic   effect  upon  the  diseased  tissues,  and  relieves  the  pain. 

Aconite  maybe  given  in  conjunction  with  Nitre  where  the 
heart  is  greatly  excited,  and  is  beating  strongly.  Ten-drop  doses 
repeated  every  two  hours  for  twenty-four  hours,  is  usually  suf- 
ficient. The  practice  of  giving  cathartics  is  dangerous,  for  it 
may  excite  super-purgation.  Usually  the  Nitre  has  sufficient 
effect  upon  the  constipation  to  relieve  it,  yet  if  it  should  prove 
obstinate,  laxatives  may  be  carefully  given.  Bleeding,  both  gen- 
eral and  local,  should  be  guarded  against  ;  the  first  because  of 
unfavorable  hyperinosis,  the  latter  from  the  danger  of  suppur- 
ation and  the  difficulty  in  securing  healing  in  some  cases.  The 
shoes  should  always  be  early  removed,  and  the  soles  left  un- 
parcd. 

Paring  of  the  soles  presents  two  objections — first,  while  it 
may  temporarily  relieve  the  pain  by  relieving  pressure,  it  at 
the  same  time  allows  of  greater  exudation  which  may  more 
than  counter-balance  the  good  effects  :  secondly,  it  makes  the 
feet  tender  and  subject  to  bruises  when  the  animal  again  goes 
to  work.  The  shoes  should  be  replaced  when  convalescence 
sets  in,  and  the  animal  ready  to  take  exercise.  Exercise  should 
never  be  enforced  until  the  inflammation  has  subsided,  for  al- 
though it  temporarily  relieves  the  pain  and  soreness,  it  serves 
to  maintain  the  tissues  in  a  state  of  continued  irritation,  in- 
creases the  exudation,  and  prolongs  the  recovery. 

If,  at  the  end  of  the  fifth  or  sixth  day,  prominent  symp- 
toms of  recovery  are  not  apparent,  apply  a  stiff"  blister  of  can- 
tharides  around  the  coronet  and  omit  the  nitre  for  about  forty- 
eight  hours.  As  soon  as  the  blister  has  drawn  well,  the  feet 
may  again  receive  wet  swabs.  If  one  blister  does  not  sufifice 
to  remove  the  soreness,  as  is  the  case  sometimes,  especially 
where  periostitis  is  present,  it  may  be  repeated,  or  the  actual 
cautery    applied.       The    same    treatment    should    be    adopted 


LAMINITIS.  37 

where  side-bones  form  or  periostitis  of  the  os  coronae  ensues. 
When  the  sole  breaks  through  and  exposes  the  os  pedis  and 
soft  tissues,  the  feet  must  be  carefully  shod — with  thin  heels 
and  thick  toe  where  there  is  any  tendency  to  walking-  on  the 
heels — and  the  sole  well  protected  with  appropriate  dressing 
and  pressure  over  the  exposed  parts.  When  there  is  turning 
up  of  the  toe,  blistering  of  the  coronet  in  front,  carefully  avoid- 
ing the  quarters  and  heels,  sometimes  stimulates  the  growth 
of  horn,  but  as  a  rule  judicious  shoeing  is  the  only  treatment 
that  will  keep  the  animal  in  a  condition  to  do  moderate  slow 
work. 

Where  suppuration  of  the  laminae  is  profuse,  it  is  better  to 
destroy  your  patient  at  once  and  relieve  his  suffering  ;  but  if 
the  suppuration  is  limited  to  a  small  extent  of  tissue,  especially 
of  the  sole,  treatment  as  in  acute  cases  may  induce  recovery, 
and  should  always  be  tried.  If  from  bed-sores  or  other  causes 
Septicaemia  or  Pyaemia  is  feared,  the  Bisulphite  of  Soda  in 
half-ounce  doses  may  be  given  in  conjunction  with  tonics  and 
other  treatment  indicated  in  these  diseases.  Regarding  en- 
forced recumbency,  I  doubt  the  propriety  of  insisting  on  it  in 
the  majority  of  cases,  for  I  think,  as  a  rule,  the  animal  assumes 
whatever  position  gives  most  comfort.  There  can  be  no  doubt 
that  recumbency  diminishes  the  amount  of  blood  sent  to  the 
feet,  and  that  the  suffering  is  greatly  relieved  while  in  this 
position,  so  that  the  experiment  of  enforcing  recumbency  may 
be  tried,  yet  should  not  be  renewed  if  the  patient  thereafter 
persists  in  standing. 

Where  the  animal  stands,  or  where  constant  lying  indi- 
cates it  to  prevent  extensive  sores,  the  patient  should  be 
placed  in  slings,  and  the  weight  supported  in  this  manner  to 
the  relief  of  the  feet.  When  all  four  feet  are  affected,  it  may 
be  impossible  to  use  slings,  for  the  reason  that  the  patient  re- 
fuses to  support  any  of  his  weight  on  his  feet,  and  simply  hangs 
in  the  slings.  Lastly,  convalescent  cases  must  not  be  returned 
to  work  too  early,  else  permanent  recovery  may  never  be  ef- 
fected. 


Fig.  1. 


Fig.  2. 


Fig.  I  shows  the  healthy  fcjot,  with  all  the  tissues  in  normal  relative  position, 
as  found  in  an  eight-year-old  gelding  destroyed  for  dissection.  The  other  cuts  are 
in  outline  only. 

Fig,  2  shows  the  changed  position  of  the  os  pedis,  as  seen  in  a  laminitic-foot  in 
the  Museum  of  the  American  Veterinary  College.  Downwaid  deflection  of  the 
bone  at  the  toe,  5  lines.  Convexity  of  the  sole,  4!^  lines.  New  horn  formed  on 
the  anterior  wall,  as  the  bone  receded,  and  hlls  the  space  between  the  present  jd'M.f?- 
/^■^'^  and  original /z^ir/zy  laminae.  Sole  greatly  thinned  from  paring.  No  turning  up 
of  the  toe. 


Fig.  3. 


Fig.  4, 


Fig.  3. — Chronic  Laminitis,  with  turning  up  of  the  toe,  from  a  specimen  in 
American  Veterinary  College  Museum,  Deflection  downward,  4  lines.  Elevation 
of  horny  toe  from  original  position,  7  lines.  Development  of  sole  beneath  the  na- 
vicular, from  7  lines  (normal  average  thickness  at  this  point)  to  14  lines.  Thickness 
of  sole  over  toe  of  ospedis,  4^^  lines,  (normal  about  6  lines).  Thickness  of  new 
horn  over  the  anterior  surface  of  the  os  pedis,  11  lines.  Horn-producing  function  of 
the  coronary  band  greatly  impaired  in  front — heel  too  long. 

Fig.  4. — External  appearance  of  the  same  foot  as  Fig,  3,  showing  the  irregu- 
larity of  the  lines  produced  by  the  alteration  in  relative  horn  growth  at  different 
points,  and  showing  the  angle  on  the  anterior  wall. 


r  y 


